Sunday, May 20, 2012

Diabetes & Low Blood Sugar; Nurses' Week; Adult Immunizations; Proper Med Lists.

Welcome back!  This blog will re-iterate & expand upon the topics discussed in the May 11, 2012 broadcast of Let's Talk Medical with Doctor Gigi.  Feel free to listen to the corresponding broadcast via www.SkipShow.com where you can find the podcast version.


Diabetes & Low Blood Sugar:

Most of us know that diabetes is a disease in which a person has a disregulation of glucose (= sugar)metabolism, resulting in the person having a high glucose.  Diabetes can lead to many bad things, including heart disease, strokes, neuropathy, poor healing, frequent infections, kidney failure, & even blindness, so anyone with the disease obviously wants to have good diabetic control.  This means that you would like to have your glucose be between 80-150.  If your sugar is often higher than this, you have a higher risk of getting these ill effects, but what happens if you get your sugars too low?

A glucose below 60 is too low, and doctors really worry if it gets below 40.  This is due to the fact that the brain needs sugar, so if your glucose gets too low, the brain actually dies.  Symptoms of hypoglycemia (= low blood sugar) include feeling anxious, confused, cold, sweaty, shaky, & agitated.  If you experience these episodes of low sugar, you can quickly correct the problem by eating sugar, so you should carry glucose pills (which you can purchase at a pharmacy) or packets of sugar (like you get in a coffee shop).  In the absence of these, you can try juice or soda... as long as they are NOT sugar-free versions.

Though we aim to control glucose to decrease the harmful effects of diabetes, we must realize that too low of a glucose can actually be more harmful than a high glucose.  When your glucose gets below 40 (or perhaps even 60), you can suffer brain damage & even death within several HOURS.  On the other hand, a high sugar (more than 150) will take YEARS to cause enough damage to result in brain damage or death.  So work with your physician to get good control of your diabetes, but don't try to have such tight control that you bottom-out & have low glucose as that will likely cause you more harm than good!


Nurses' Week:

We recently celebrated Nurses' Week.  This celebration begins on May 6th & ends on May 12th... which is the birthday of Florence Nightengale, who is the founder of modern nursing.  Though being a nurse often involves doing tasks which are less than glamorous, it is in my opinion the closest thing to being a mother.  Nurses care for us when we can't care for ourselves, & they do so without judgement or malice. Though they often make us do things we don't want to do, they do it for our benefit.  They are the quiet support that hold our hands & care for our dignity & emotions, as much as they care for our physical health.  They do more for us than we know, & during this week, we celebrate those nurses, past, present, & future who give so unselfishly of themselves to care for us!  And though they might not love us like our mothers do, the service they give us is done so with love in their hearts!


Adult Immunizations:

Though we are aware that children need immunizations, we often forget that adults also need certain immunizations.  Perhaps because schools mandate proof of immunizations, most children get their shots.  On the other hand, no one insures adults get their shots, so consider the following & discuss with your doctor to be sure you keep up-to-date.

There are generally 4 adult immunizations Td or TdaP (tetanus & diphtheria without or with whooping cough), Pneumovax, Flu, & Zostavax (shingles).

Td stands for tetanus & diphtheria, & everyone should get one every 10 years, unless they have had a problem with previous Td shots.  This shot protects us from getting tetanus, which is also called lock-jaw.  Though we mostly think we are prone to tetanus when we get a rusty nail injury, any open wound can be a source of tetanus.  Thus, even a clean wound predisposes us to tetanus, so it behooves us to keep current with this shot!  Unfortunately, if you have Medicare benefits, Medicare will only pay for the Td shot if you have an open wound.

TdaP is the tetanus & diphtheria shot with whooping cough as well.  Whooping cough does not usually harm adults, but it can kill or permanently injure children.  Most kids get DPT shots which include whooping cough, but not every child will make proper immunity, so we still want to immunize adults to decrease the risk of an adult getting the disease & spreading it to a susceptible child.  So adults have the choice of Td or TdaP... & those who have frequent exposure to children should opt for the TdaP.

Pneumovax is a vaccine to protect you from getting Strep. pneumonia... which is a bacteria that often causes sinusitis, ear infections, pharyngitisbronchitis, & pneumonia.  It is recommended that anyone who is prone to these respiratory illnesses (such as those with asthma, emphysema, or even chronic allergies) should get a Pneumovax shot every 5 years.  Everyone older than 65 should get this shot.  Medicare will pay for only one shot after the age of 65, unless you have high risks for respiratory infections as noted above, though I recommend all of my patients over 65 continue to get this vaccine every 5 years, even if they have to pay cash for it.

Flu shots are given every fall in an effort to protect the population from influenza.  As the shot changes every year, it is given to virtually everybody every year.  Again, those who are highest risk of respiratory disease should get this shot annually, but it likely is a good idea for everyone to get one.

Zostavax is the vaccination which helps decrease the risk of getting shingles, which is also known as Herpes Zoster.  When a person gets Chicken Pox, the virus causes infection & then goes dormant in the body.  If it re-awakens many years later, it causes shingles... which is heralded by a classic painful, blistery, red rash which involves only one side of the body.  Anybody older than 50 can get a Zostavax, but unfortunately it is expensive, costing $250-$300 or more.  Because of this expense, many wait to get this vaccine when they have Medicare coverage, as Medicare Part D will usually pay for it.  Oddly enough though, it is covered as a pharmacy benefit, so most physicians cannot bill for it so they do not give it.  Instead, it is recommended that you go to a pharmacy with an in-house walk-in clinic... such as CVS or Walgreens... where the doctor or nurse can get the vaccine from the pharmacy, administer it, & then bill your pharmacy insurance.  If you wonder why you can't just pick up a vial of this stuff from the pharmacy then bring it to your doctor to be administered, it is because it must be given to the patient within 30 minutes after being removed from the freezer.


Proper Medication List:

Just a note to make you aware that as a physician I would love for my patients to keep a list of their medications.  I have noticed however that they do not record the meds as I would like, so here's a few helpful hints.

The list should include the name of the medication, preferably the generic & name-brand if you know... as different doctors will use different names.  Also, include the strenghth of each pill AND how many you take & when you take them.  This seems straightforward enough, but patients sometimes try to help me by writing the total dose they take in a day... yet I need to know the way the prescriptions are written.  For example, if a patient takes Pravachol 40 mg 2 pills with supper, this is how I want it recorded.  If the patient writes Pravachol 80 mg per day (their total daily dose), I will likely write the prescription for an 80 mg pill which is more expensive than 2 of the 40 mg pills.  Also, if the patient calls to ask a question about the "2 pills" he takes at night, there will be a disconnect in our communication if my records indicate he is taking one pill at night for his cholesterol problem.  Be accurate & be honest when you write your list, as it will help protect you from medication errors in the long-run.

An example of how this can make management difficult, I recall a recent situation at a local hospital. One of my patients was being treated for an infection but also had some chronic pain.  Unfortunately he also had a swallowing problem, so swallowing pills was difficult for him.  I ordered MS Contin 30 mg one pill 2 times per day, so I was confused & agitated when the patient complained repeatedly about having to take 6 pills every morning & 6 pills every night.  I checked the computer & could not find where he had 6 pills of any type ordered, so I spoke with the nurse who checked her records.  Her records showed that the pharmacy did not have the 30 mg pills, so they had switched to six of the 5 mg pills for each of the 2 doses.  Though there would usually be no problem with this substitution, it certainly was a problem for my patient with swallowing problems!  And worse yet, it was a problem for all of us because the records did not show me an accurate med list, so this impaired my ability to properly care for my patient


Until next time, you can catch us on the radio... WTAN 1340-AM on Fridays 1:00-1:45 PM in the Tampa/St. Petersburg, FL area, or on the web... www.SkipShow.com where you can listen live or to the podcasts.  We are always happy to answer your questions, so keep them coming... (727)-441-3000 or tollfree (866)-TAN-1340 or DoctorGigi@SkipShow.com.  And if you find this blog educational & worthwhile, please become a "follower" & please consider sharing the link with your Facebook & Twitter friends!  By the way, I will soon have a central website for the podcasts & this blog, so stay tuned for the opening of www.DoctorGigi.com.

Here's to our health!

Doctor Gigi

Monday, May 14, 2012

When Should We Die?; Quality of Life & Living Wills; Euthanasia; Zostavax shot; Protein in Diet; Birth Control & Blood Pressure.

This blog corresponds to the May 4, 2012 broadcast of Let's Talk Medical with Doctor Gigi.  Feel free to refer to the podcast of that show via www.SkipShow.com if you want to hear us speak about these issues, & as always, please feel free to leave comments here or call us during the live show on Fridays at 1PM Eastern time... (866)-TAN-1340 tollfree.


When Should We Die?:

All machines break down at some point, so when should the human body break down?  Are we really doing good to make discoveries that increase one's life expectancy? 

I believe that the human body can certainly live well into the 90's or even longer, but at some point it does become frail & ill, & there is little if anything we can do to reverse or cure that.  Also, if you want to be the lucky person who lives a healthy life to that age, you must make good choices in your life!  You must eat right, sleep well, exercise routinely, find joy in life, & love & be loved!  You also pray that you received great genes from your parents, as some issues that effect your life expectancy are not within your control.  Even environmental issues such as where you live will have tremendous impact on your health, as we unfortunately learned from the Love Canal incident in New York.

Obviously we spend a lot of money trying to find medications which impact our health.  The best option however is to stay healthy... so we should all aspire to do that!  Realize that you have but one body, & affirm to take great care of it, as we can not always reverse the damage a poor or risky lifestyle causes. 

So we all want to live to be old & die of old age, but "old" seems to get older as we age.  I guess that "old" might even be more defined by one's quality of life than by a distinct number of years which they have lived.  Thus a sick 50 year old person might be "older" than a healthy 70 year old.

But when should we as humans die?  Obviously no one wants to die if they have good quality of life.  But, without older generations dying, how can Earth support the overpopulation?  So life & death become not only a health issue but a socio-economic one as well.  If we want to live longer lives, we need to use birth control appropriately & thus decrease over-population.  Thankfully, we seem to be doing a better job at that as the birth rate has recently declined.  We must also realize that if we live longer, we will need more money for those elder years, thus retirement age will have to go up.  This means the work-force will not have as rapid a turn-over, so jobs for younger people will be hard to find.  Again, a population issue! 

So one of our listeners posed a question:  Do I support the one-child policy?  I really don't like laws which restrict choices, but I would like it if people would adopt this belief.  People should make choices to not over-populate the world, & at the very least, we should be responsible enough to not have more children than we can comfortably feed, educate, & love.  So judge your own circumstances & make your own choices, but keep these issues in mind!


Quality of Life & Living Wills:

A study several years ago discovered that the majority of the Medicare money is spent in the last 90 days of a person's life.  While we do not want to give up hope when a person gets ill, we do need to recognize when treatment becomes futile.  At the present time, our government & health insurance plans are looking at ways to cut costs.  They are toying with the idea of withholding certain treatments based on age.  I would rather that we withhold care based on the likelihood of a good versus bad outcome, as this would take into account more important issues than simply a person's age, & certainly seems more scientific to me.  Thus a 35 year old with a brain injury who must live in a nursing facility, & who cannot talk or travel might not qualify for aggressive chemotherapy for cancer, whereas a healthy 75 year old who lives independently, cares for himself, & continues to drive might qualify for the treatment.  I propose that before we get arbitrary guidelines, we need to start using common sense & make our own good choices! 

We also need to make Living Wills which express our wishes to not be kept alive if there is no chance for meaningful recovery, & we must discuss this with our families so they are prepared to honor our wishes when or if the time comes.   When a physician approaches a family member to ask if he can abide by the Living Will & thus withhold treatment, he is not really asking you to decide about heroics for your family member.  In fact, your family member has already made that decision, & you can only decide to allow the doctor to follow your family's written wishes or not.  So you are not letting your family member die, you are simply following their wishes as expressed in the written instructions we call a Living Will. 


Euthanasia:

Though I believe in euthanasia, I am not certain that I could actually perform it.  I have had my pets euthanized, & though I know it alleviates suffering, I don't know that I could do it.  I am thankful however to have Hospice available, as they too ease a patient's suffering, & their pain medications likely expedite death a little... as they suppress respiratory drive.  If you or a loved one has a terminal illness, you likely qualify for Hospice.  You could instead have "the dwindles" which is not truly a disease, but rather a "failure to thrive."  In this instance, we simply know that you are slowly dying, for whatever reason.  There is a thought that you must have only 6 months of life left to qualify for Hospice, but that does not mean that you have to die in 6 months.  Hospice can provide longer term care if needed, so ask your doctor if you think you need their services, or if you prefer, call Hospice directly to speak with them yourself.


Zostavax Vaccine:

If you have had chicken pox, you are prone to getting shingles, as shingles is a reactivation of the chicken pox virus which continues to live in your spinal cord area after your initial infection.  Shingles is a painful, red, blistery rash which wraps around your body in a nerve distribution.  This means it will cover a stripe of skin on the right or left side of your body, & it never crosses the midline or middle of your body.  It can cause pain before the rash even appears, & usually the pain is pretty severe.  The older you are the more likely you will get it, but thankfully most people only get it once.  Younger people usually get better, but older people can end up with chronic pain, called post-herpetic neuralgia, which can be so severe that it is debilitating.

Zostavax is the vaccine which helps decrease the chance that a person will get shingles (also called herpes zoster).  Thus, it is indicated for people 50 years old or older, as they are prone to the disease, & if they get it, it is possible that the pain might never resolve.  Generally we believe you only need one Zostavax injection in your lifetime.  The vaccination costs about $250-$300, & most insurances do not pay for it, but Medicare Part D (which pays for the Medicare recipient's medications) will pay.  Thus many people wait to get the shot when they are 65 years old as that is generally when they get Medicare benefits.  If you really want to get a Zostavax shot, call your insurance to see if they will pay, but if they won't, you have the option to pay for it yourself.  Though $250 or $300 is a lot of money, it is probably money well spent to avoid chronic pain.


Protein in Diet:

Linda asked about the amount of protein a woman should have in her diet.  First, realize that very few doctors understand nutrition very well as we do not get a lot of nutritional training in medical school.  Dieticians are the specialists who know this stuff, so if you have tremendous concerns, see a Dietician for input.  I think that a person's diet is supposed to be composed of 40% protein, 30% carbohydrate, & 30% fat.  As everyone has different caloric needs due to their age, sex, weight, genetics, activity, medications, etc., you must first determine how many calories you truly need each day.  You might discuss this with a Dietician or perhaps you can get a guesstimate by using on-line calculators.  Once you have the total calories you need in a day, you multiply by 0.4 to get the 40% of calories which should come from protein.  Lastly, you must know that 1 gram of protein = 4 calories, so you must divide the protein calories by 4 to get the number of grams of protein you should have per day.  You should also know that 1 gram of carbohydrate = 4 calories, but 1 gram of fat = 9 calories

For example:
Let's assume I need 2,000 calories per day to maintain my weight.
     2,000 calories X 0.4 = 800 calories which should come from protein.
         800 calories of protein divided by 4 calories/gram of protein = 200 grams of protein needed/day.
     Based on the above, you would need 2,000 X 0.3 = 600 calories from carbs, & 600 from fat.
          But due to the different calories in these, you would need 600 divided by 4 = 150 grams of carb, but 600 divided by 9 = 66 grams of fat.

Lastly, if you have certain diseases, the above might not apply to you.  In particular, people with liver disease must limit their protein intake as otherwise they produce excess ammonia which acts a bit like alcohol to make them not think clearly.  Thus a person with significant liver disease should see a dietician to learn how to eat properly as their needs are somewhat unique.


Birth Control & Blood Pressure:

A patient was recently told that her blood pressure was high, & that due to this she needed to stop her birth control pill.  Birth control pills are usually a combination of estrogen & progesterone, & estrogen can increase blood pressure

First, as she had never had high blood pressure, she must stop the birth control pill, but she must also look for other things that might have caused the high blood pressure.  She should stop any products for weight loss as these can elevate the blood pressure.  Similarly she should limit decongestants (such as Sudafed, Pseudoephedrine, & Phenylephrine) & caffeine, as well as alcohol.  She should try to exercise & perhaps lose weight (if she is over-weight).  She might need to consider a sleep study to look for sleep apnea, especially if she is obese & snores a lot. 

If the blood pressure normalizes, she could then re-try the birth control pill, but if the blood pressure again increases, she probably should not take the pills any longer.  There is a progestin-only pill which she might try, as this should not effect the blood pressure, or perhaps she could simply use condoms & a spermicide.  If she is older & in a stable relationship, an IUD might be a good option or perhaps even a diaphragm or a cervical cap would be acceptable.  There is a new procedure called Essure which is a permanent, non-surgical, non-hormonal procedure that will cause blockage of the Fallopian tubes thus preventing pregnancy as the sperm cannot get to the egg.  It is basically a non-surgical tubal ligation which is performed in several minutes in the office, but it is NOT reversible, so it is considered a form of sterilization

Obviously there are many good options in this situation, & the final choice will vary based upon the patient's age, relationship status, & desire for pregnancy in the future.  As always, a discussion with her GYN or Family Practitioner should help her make the most appropriate choice for her.


I hope you learned something useful in this blog, & please consider listening to Let's Talk Medical with Doctor Gigi on Fridays at 1:00PM Eastern time.  We are broadcast locally on WTAN 1340-AM in the St. Petersburg/Tampa area, but you can also find us on the web via www.SkipShow.com where you can listen live or to the podcast at your convenience.  Keep in touch & don't hesitate to contact me with questions or comments: (727)-441-3000 or (866)-TAN-1340 which is toll-free, or DoctorGigi@SkipShow.com

Here's to our health!

Doctor Gigi

Sunday, May 6, 2012

Weight Loss Programs; Medical Credentials?; Beano; Weight Gain & Anti-Depressants; Depression; Over-used Tests.

Welcome back to the Let's Talk Medical with Doctor Gigi follow-up.  This blog refers to the show which was broadcast on Friday April 27, 2012


Weight Loss Programs:

I am certainly no expert on weight loss programs, though I did attend a weight loss program myself when I was a teen, & I even underwent a suction lipectomy when I was 24.  I also used to work in a Phen-Fen clinic years ago, so I do understand the desire to discover a magic bullet for obesity!  Unfortunately there still is no such thing.  Though many programs exist, no one program works for everybody, so I really can't suggest one over the other.  I would however like to make you aware that if the program involves an herbal supplement, that supplement is on the market as a food product only.  In other words, unless it is a prescription medication, it has not been evaluated as a medication by the FDA; thus, it is treated as food.  No one evaluates food for safety or efficacy, so again the claims of weight loss have not been verified... unless it is listed on the product label (which cannot make false claims).  So be cautious of supplements, & realize that the gold standard weight loss programs involve a decrease of calories eatenAND an increase in calories spent.  I like healthy meal replacements like Jenny Craig as they give you complete nutrition but help limit your caloric intake.  Be sure to increase your activity, even if you just take a brisk 30 minute walk every day or two, as this helps to increase your metabolism thus burning off the calories more effectively.

Also, just because a physician has a weight loss program in his office does not mean that it is a great program or more medically sound than others.  It also does not mean the doctor is going to oversee the program, as sadly most doctors have had very little training in obesity & nutrition.  There is a specialty in Bariatrics which we can obtain if we wish to learn more about this, but few docs truly pursue that training.  The draw for physicians to have weight loss programs in their offices is usually a financial incentive, as usually it is a cash pay program.  Unfortunately, doctors no longer make ancillary income through ownership in labs, home healthcare agencies, radiology suites, or medical supply companies.  This, along with the increased costs of running a medical clinic, as well as fairly stagnant fees (which are controlled by insurance companies &/or the government) has resulted in many physicians looking to do things which bring in cash money... as these cash pay services are not controlled by insurance or government


Medical Credentials?:

All physicians have an MD or DO degree, indicating that he has a doctorate degree in medicine.  After that however, that are many different residencies which train us to be specialists.  Many of the procedures done by one specialty are also done by other specialists.  Thus an ENT doctor might do a face lift, as Plastic Surgeons are not the only group trained to do this.  After the doctor becomes a specialist, he can also choose to study in other programs to achieve the knowledge needed to do certain procedures, such as liposuction or face peels.

The point is that many doctors are qualified to do procedures, & they get that training in a variety of ways.  You as the consumer have a right however to know what the doctor's training is, so don't hesitate to ask... especially if you are paying cash for a procedure as you are a person who has a choice...


Beano:

Beano is one of my favorite products!  It is basically a digestive enzyme which humans do not have.  It digests certain carbohydrates which are found in gassy foods such as beans & cabbage.  Unfortunately the bacteria which live in your bowel do have this enzyme.  So when you eat these foods which you cannot digest, the food gets to your bowel where your bacteria do digest the carbohydrate... and the byproduct of that digestion is methane gas.  So, if you take Beano with these foods which you cannot digest, the Beano will digest the carb so by the time the food gets to your bowel the bacteria have nothing to do, thus you get no gas production!  Yeah Beano... natural & effective!


Weight Gain & Anti-Depressants:

Many anti-depressants do cause weight gain.  The most notorious for this is Paxil, & I can remember this as we used to say:  "Paxil packs on pounds."  In all fairness, this is probably an issue with all SSRI's, including Paxil, Prozac, Zoloft, Celexa, & Lexapro.  Though Paxil is thought to be the worst offender, it has been modified to decrease it's side-effects including this one.  Paxil was changed slightly to create Celexa, which was in turn modified to create Lexapro.  So perhaps Lexapro (which just went generic) has less weight-gain issue than other SSRI anti-depressants.  There is a new anti-depressant named Viibryd (Vilazodone), which is a special sort of an SSRI.  It has studies which actually show it does not cause weight gain.  If reality proves to be true, it would perhaps be the preferred SSRI anti-depressant as it is also reportedly well tolerated, has little to no sexual dysfunction side-effects, & has less likelihood of a "poop-out syndrome"... call or e-mail if you want to know more about what that is!

We don't really know why weight gain occurs with anti-depressant use, but some propose that they cause the patient to crave carbs, which might result in increased calorie intake.  So I try to remind my patients to be cognizant of this carb craving & to try to make an effort to limit carb intake... & instead to increase protein intake as this tends to be more filling.

So what can you do if you have depression, but are concerned about your weight?  First, watch your carbohydrate intake.  Secondly, ask your doctor if Wellbutrin (= Buproprion) is an option.  Remember however that although Wellbutrin is a good anti-depressant which is associated with very little in the way of weight gain & sexual dysfunction, it is not good if that depressed person also has anxiety.  By the way, the SSRI's (see above) are the best for treating depression AND anxiety.  Another option is to try an SNRI such as Effexor (= Venlafaxine), Cymbalta (= Duloxetine), Pristiq (= Desvenlafaxine), or Savella (= Milnacipran), but they often cause weight gain also.  Lastly, perhaps you should simply take the best anti-depressant for you, & when you feel better physically & emotionally, make better choices regarding your diet & exercise, as often depressed people don't exercise or eat properly.

As a final thought, hypothyroidism is a condition in which a person's thyroid functions too slowly.  The thyroid is essentially your metabolic gland, so when it is slow, your metabolism is slow & you tend to gain weight.  Also, when you have a slow thyroid, you tend to be depressedSo every depressed patient needs a TSH blood test to rule-out hypothyroidism as part of the problem.


Depression:

How do you know when to take medication for depression?  First we need to understand that depression can be due to outside influences, such as unemployment or relationship issues.  But depression can also be due to a chemical imbalance in the brain.  It is this chemical imbalance which is corrected by the medications we call anti-depressants.  Though some anti-depressants replace the serotonin in one's brain, others replace norepinephrine, & still others replace dopamine

Depression is like any other disease... it has a stepwise method of treatment depending upon a patient's disease severity & personal choices.  I suggest that it is similar to diabetes.  If you are diabetic, it is first your responsibility to eat right & exercise.  If that does not control your diabetes, then you might need pills, & ultimately you might need insulin.  So a depressed person should first try to deal with life issues within his control, & perhaps try counseling, but if that is not successful, perhaps medications are necessary... to correct that chemical imbalance.

Realize that anti-depressants often do not work well until you have been on them for 6 weeks, so it is important not to wait too long to try them.  There is no shame in trying an anti-depressant, & you can certainly stop at any time, but they work best if you take them for about one year.  They also can cause a withdrawal if you stop them too quickly, so always speak with your doctor before you abruptly stop or skip doses.  The withdrawal is not an indication that the anti-depressant is addicting however.  The anti-depressant replaces certain chemicals in the brain (as noted above), so when you abruptly stop your pills it takes a while for your brain to try to produce those chemicals, resulting in odd feelings such as shock-type feelings in your body & brain.  After a few days this will resolve, but slowly weaning your dose should prevent withdrawal from occurring.


Over-used Tests:

Recently each of 9 specialty organizations in medicine, including mine... the American Association of Family Physicians... chose 5 tests which they feel are over-used in practices today.  This establishes 45 procedures for which our specialty organizations have given us guidance to help decrease over-use... likely in an effort to rein in healthcare spending.  Most make sense & should not result in withholding of care.  Instead, this sets guidelines which allows doctors to decrease inappropriate use of tests by applying scientific principles to when & why tests should be conducted.  Also, by having these guidelines, doctors have created a means of protecting ourselves from lawsuits which might claim that we did wrong to a patient by delaying such tests.

Remember however that these are only guidelines.  A patient & his physician can always opt to do more agressive testing if the situation calls for it, so be sure to speak with your doctor if you have concerns, as exeptions can always be made.  I think the point of all this is that because we live in an educated society, we have gotten to the point where much of medical care is done at the demand of society or to protect the doctor from lawsuits.  These guidelines will help get doctors back in control of the practice of medicine which should help with the tremendous costs of healthcare. 


And so this concludes another segment of the blog.  Hopefully you found something useful in it, & don't forget to share with your friends & family as perhaps they can learn something useful as well.  And don't forget to tune in on Fridays at 1:00 PM Eastern time when we broadcast Let's Talk Medical with Doctor Gigi live on WTAN 1340-AM in the Tampa/St. Pete area.  If you are not local, you can catch us on the computer via www.SkipShow.com where you can listen live or to the recorded podcasts.  As always, I happily accept questions & comments, & you can reach me during the broadcast via:  (727)-441-3000 or toll-free (866)-TAN-1340, or you can e-mail me any time via:  DoctorGigi@SkipShow.com.

So until the next time, here's to our health!

Doctor Gigi